In Loving Memory of Hudson James Mendralla

You were my world, Jimmy James.  We'll miss you forever and you will never be forgotten.

Hudson James Mendralla

June 2004 to June 2012

Hoover

Huddy Buddy

Budda Boo Bear

Hoober Boober

Haboobers

Boobers

Prince Habiboo

Bouncing Baby Boobers

Bare Butt Bouncer

Jameson

Jimmy James

Jimmy Shimmy

Shimmy Jamepoo

Shampoo James

Shimpy James

Jimfee

Big Velvet

Greystache

Theirs not to reason why, Theirs but to do and die

 On Saturday, June 23rd, Tony and I said goodbye to our beloved Hudson.   Hudson came into our lives in December 2006.  He was our very first big dog and taught us all about the true meaning of “gentle giants.  He was a patient brother to his bossy little sister, Lexi, and a protective tough guy for his timid brother, Porter.  He was a goofy boy who loved to play, even if it wasn’t playtime.  One of his favorite fall past times was tearing open the bags of leaves that we had just raked and making nests of the leaves.  He loved the water and spent each summer lounging in his wading pool at home.  One of his favorite places was the dog pool at City Bark Parker.

Hudson was a people lover and never met anyone he didn’t like, but he was a mama’s boy through and through.  Wherever I went, he had to go too.  We had a special bond that can’t be put into words.

In May 2011, Hudson started limping.  After lots of misdiagnoses, it was determined that he had Osteosarcoma.  He underwent an amputation surgery three days later.  Four hours after his amputation, he got up and was walking.  Some big dogs struggle for a week or more to learn how to walk without one of their legs.  I remember the vet tech calling me in tears to update me on how well he was doing hopping around the lobby.  Three weeks after surgery, Hudson began IV chemotherapy treatments.  He was a trooper through everything, and a sweetheart to all his doctors and techs.  Our oncologist confided to me that his appointments were automatically scheduled to last 20 minutes more than any other dogs because the staff all wanted time to see him.  Before chemo, he would be paraded through the back rooms of the hospital visiting all the techs and specialists, even if they didn’t work with him.

Chemo fought back the cancer and while he did get metastases in his lungs, he was considered in partial remission since they were not growing.  Hudson was happy, healthy (aside from the cancer) and enjoying attending BDHP events as a Great Dane ambassador.  Sadly, in May, we began to notice lumps under his skin.  When biopsies were performed, they were found to be osteosarcoma.  Only 10% of osteosarcoma cases metastasize in the skin, once they do, they begin to attack the liver hard and fast.  Our vet hypothesized that he had 2-3 months of quality life left.

Soon thereafter, we began to notice a decline.  He was still feeling fairly good, but he was sleeping a great deal more and tired easily.  On Wednesday night, the 20th of June, he began limping on his front paws and we knew we were in trouble.  We took him to his oncologist on Thursday and were told that the cancer had moved to his front leg.  Amputation wasn’t an option.  Osteosarcoma is extremely painful and drugs only dull the pain, so we made the very difficult choice to let Hudson go.  He went home with us and was spoiled rotten the next few days.  His final dinner was a medium rare steak from Outback, with a Chocolate Pecan Brownie Sundae for dessert.

Hudson passed in our arms on Saturday evening, surrounded by his family at home.

Hudson was an inspiration.  He got us involved in rescue, which has become one of our greatest passions.  He has given hope to others fighting the cancer battle or facing an amputation. Three different vets offices have taken videos and pictures of him bouncing around on his three legs to show to families who are facing the decision to amputate.  Hudson and I have personally met with four families dealing with amputation and/or chemo to talk them through their doubts and offer hope for the future.  We will be forever grateful that we had the chance to love him and be his people for 5 ½ years.  He taught us what it was to be brave in the face of overwhelming odds, and how to battle them with grace and strength.  He will be forever missed and leaves a huge hole in our hearts.

I Knew What They'd Say Before They Said It

Hudson started limping on Wednesday night, June 20th.  As soon as I saw it, I knew we were in trouble.  There are those who will say "Look on the bright side, he may have just pulled a muscle."  Those people have not been living with him for the last two weeks.

Hudson has been tired.  He sleeps most of the day.  He still plays and has fun for short periods of time, but he tires quickly.  He is still eating, but he isn't finishing.  He won't even start without being tempted with a little something delicious being added to his bowl.  I knew he hadn't been active enough to strain anything.

He already had an oncology appointment for the next afternoon, so I gave him a little extra Tramadol until then.  Upon arrival, we weighed him and he had lost three pounds since our last visit.  I talked to our oncology tech and gave her all the details of what we were seeing at home, and pointed out that all his subcutaneous lesions seemed larger and that the mass in his mouth had grown over his teeth.  They were no longer visible.  I also requested that they x-ray his front left leg, which seemed to be the one he was favoring.

They took him back and Dr. Glawe began measuring the changes in his sub-cu tumors.  Before she even did the x-ray, she came out to talk to me and ask me "where my head was at."  I told her I knew what the x-rays were going to show and that we were prepared to deal with the outcome.  We had already selected a vet that could come to our house and allow Hudson to pass with his family around him.  We were prepared to let him go on Friday night, if necessary, but that I needed her direction in that aspect.  I didn't want to let him go too soon, but I didn't want him to suffer either.

Dr. Glawe shared that Hudson's blood count (both white and red cells) were in the normal range, precluding anemia and low white cell count as the reasons for his lethargy.  The mass in his mouth had grown from 0 to 4 cm in diameter in three weeks.  The subcutaneous nodules had both grown 20% larger as well.  Clearly, his cancer is progressing.  I confirmed that I wanted to have xrays done anyway, in spite of his obvious decline.

The x-rays showed a new bone lesion of the proximal humerous.  Approximately 50% of the cortical coverage remained in place, so a pathologic break was not imminent, but Hudson was in pain and there was nothing, aside from radiation, that could be done.  There was no guarantee that radiation would in any way extend his life, and it certainly wouldn't help him to feel better.  We made the hard decision to let him go in the next 24-48 hours.

I had Friday off of work and spent the vast majority of the day with Hudson.  We napped, we ate hamburgers and we played with his favorite toys.

I had to host a bridal shower on Saturday, so Tony got to spend a day with Hudson as well.  They cuddled and napped together, ate lots of treats and played with toys.  They lounged outside in the sun and laid in the grass together.

Dr. Magnusson was scheduled to come over at 8:00 PM, so we soaked up the time we had left with our boy.

Trying to Stop Your Leaving

Got a pebble, got a pebble in my hand

And I toss it out into the middle of the Rio Grande

But the river keeps running

Don't even know that I'm around

I can throw in a million more and not slow it down,

And that's kind of the way I'm feeling,

 Trying to Stop Your Leaving

There's nothing I wouldn't try

If I thought it would change your mind

Trains a'coming, Rivers running, Pains a'coming, Tears a'running...and that's kind of the way I'm feeling, knowing I couldn't stop your leaving

Please Understand....

I've begun counting the minutes left with my boy.  This means that every single time I have to leave him, I have to evaluate how much time I lose.

When I turn down your Happy Hour invite, please don't be upset.  It's nothing personal.  When I don't show up to the event you very generously chaired, please don't be insulted.  Hudson isn't really up to long visits anymore and I'm not going anywhere without him.  It's bad enough that I have to go to work everyday.  I don't want to regret wasting any more time with him that.

Regrowth

Hudson's oral tumor has already grown back and is approximately 1/2 the size it was before he removed it.

Clearly, his cancer is getting aggressive.  I spoke to his fill-in oncologist and Dr. Glawe agrees that surgery every 2 weeks to remove the tumor isn't feasible.  We are continuing to treat with oral chemo, but have added Tramadol to the mix to try to keep him comfortable.  The regrowth was a hard blow to take.

We've really been noticing that Hudson is slowing down in the last week.  He spends a great deal more time sleeping, he's eating less (but still eating!!) and his enthusiasm for seeing people is waning.  He's delighted to see people when they come to visit, but he tires quickly and goes to lay down.   I think a large part of this is that he is unwilling to expend the energy trying to get around Porter who is an attention hog, but it still breaks my heart.

He still likes to play, but his play sessions are getting shorter and his naps are getting longer.  We have another oncologist appointment on Thursday the 21st (one week away.)  I'm considering requesting a x-ray or ultrasound of his liver to see how much it is under attack, but I'm not sure that I want to know.

Hudson still looks good and he doesn't appear to be feeling bad yet.  It's not time just yet to say goodbye, but it's coming, and sooner than the 3 months I was hoping for....

Hudson : Oral Surgeon MD

Hudson did not have his surgery on Monday the 4th.  Why, you ask?  Because he chose to remove his tumors himself.

When we first adopted Hudson, he was reactive to thunderstorms.  He ate through the wood panel in his big ol' dog house.  After that, we started leaving him inside and the problem seemed to solve itself.  Until Saturday the 2nd....

Tony and I had gone to the Parisian Market at Aspen Grove with my mom.  Out of nowhere, a storm blew in.  We headed home, but not soon enough.  Apparently, when the thunder began (which we didn't even hear at Aspen Grove) Hudson panicked and decided that he needed into the master bedroom.  We had shut the door when we left, so he decided to eat his way through.

This picture was taken after the pieces of door were picked up and the blood scrubbed from the carpet.

When we got home, there were blood droplets all over the wood floor at the base of the stairs.  We assumed someone had sliced open a paw or something and checked everyone's feet for damage.  Nothing.  I began cleaning up the mess.  The blood trail continued up the carpeted stairs, so I followed it to evaluate the damage done to the carpet.  When I reached the top and turned the corner, the destroyed door greeted me.  Figuring that it was Hudson, based on his reaction four years ago, I checked his mouth.  His tumors were gone and blood was flowing sluggishly from the wound.  I called the ER vet to explain what had happened and they suggested I bring Hudson in, but our favorite vet tech, Megan, wouldn't be back for 20 minutes.  Since it wasn't a true emergency, I decided to get a headstart on cleaning up the mess before we left.  I grabbed a trash bag and began picking up all the splinters of wood.  On the fourth handful, I felt something squishy.  It was the largest of the tumors.  I then sorted through the debris to find the other.  I bagged them up and left Tony to finish removing the devastation.

Upon arriving at Animal Hospital Specialty Center, Megan came and met us at the door and walked us back.  I gave her the bag of tumors and she took Hudson back to have him assessed by the doctors on duty.  They all felt that surgery was no longer necessary, as Hudson had removed the growths down to the gumline.  He was already on amoxicillin and the bleeding had stopped.  They rinsed his wounds out to make sure there were no splinters embedded and sent us home.  (Free of charge.  They are wonderful people over there.)

Exam Room #2

This is the room where I was told, one year ago today, that my dog had cancer. The odds of making it this far were 50/50. This is the same room where I was told two days ago that he is nearing the end.

Hudson has battled for a year with a strength and will that I can only marvel at. He has remained my goofy momma's boy and he comforts me far more than I have comforted him. Regardless of how much time we may have left, this whole process has been worth it. Every dollar and every tear. I would give it all again to keep him with me.

The Day I've Been Dreading

Since our last visit, the infection in Hudson's mouth has gotten much, much bigger.  I called and asked if I should bring him in last week, but the back up oncologist is only in on Thursdays.  I could have seen the internalist, but I won't lie, I wanted a board certified oncologist to look at it, rather than have someone else guess.

The cytology done last time came back negative, but Dr. Janson had also said that they couldn't find a lot of tissue to look at.  It was mostly blood when the needle was stuck in.  The mass has increased to four times its original size and Dr. Glawe, the back up oncologist, is fairly certain it's another metastatic osteosarcoma tumor. In addition to the increase in the mouth mass, we found two other new subcutaneous lesions during this visit.  While the Kinavet is doing it's job and decreasing the size of the shoulder mass, it isn't stopping new growth.

The mouth mass is painful for Hudson, so we have scheduled surgery on Monday, June 4th to have it removed by Dr. Stubbs.  This will be a debulking procedure to make him more comfortable, but will not remove all the affected tissue.

We could start Hudson on Leukeran, if desired.  It, like Kinavet, is not intended to treat Osteosarcoma tumors.  Both are intended for mast cell cancers.  The chance of efficacy is only 20%.  Palladia is also an option (and a mast cell chemo,) but side effects are 75% likely and include GI upset, urinary concerns and internal bleeding.  While we have been lucky with Hudson and he has experienced very few chemo side effects, I am not willing to put him through the side effects that could occur on Palladia.  We've already seen that his cancer is very adaptable.  No matter what chemo we put him on, the cancer is twisting itself to become immune to it.

 Hudson is like a garden.  The seeds of the weeds are already there.  For each one we pull, another pops up in a different location.  This is why we are choosing not to remove the subcutaneous lesions.  The fact that he has developed multiple masses since our last visit is very concerning.  While he is still feeling good at home and hasn't been sick, the rate at which he is developing new masses has led Dr. Glawe to expect his quality of life to begin to decline in the next few months.  She is estimating that he has 2 to 3 good months left.

Working from Home with My Kids

One of my favorite things about my job right now is my Work-From-Home-Fridays.  I sit at a table outside with my laptop while my babies sunbathe. J

 Hudson is channeling his inner bad-ass Dane by faking some cropped ears. J

Accupuncture

Porter has been diagnosed with three different spinal conditions in three different locations of his spine.  Dr. Landy didn't feel that pain meds were needed at this point, but suggested that Porter be brought in for accupunture to relieve some of the pins and needles discomfort that he is likely feeling.  Since Hudson has GOT to be sore as well from changing his gait, I decided to start bringing him as well.

Normally, Dr. Rob does his accupuncture while his patients rest comfortably on the couch, but my guys are too big for that.  That doesn't stop Porter from taking over the couch while we wait. :)

Acupuncture has helped Porter tremendously.  He experiences nervous tics in his face that have dropped off significantly since we began acupuncture.  Dr. Landry has been really pleased with his reaction and his gait has certainly improved.  We don't hear his nails dragging nearly as much when he walks and he doesn't slip as often on the wood floors either.

Hudson was very sensitive in his back end when we first brought him in.  That makes sense, since he has already been diagnosed with spondylosis.  One of my fears when proceeding with the amputation was that he would perhaps have difficulty hopping on one leg with his pre-existing condition.  Acupuncture has helped tremendously.  His reactivity to the needles is much less than the first visit.  He gets up easier now and we are seeing less slipping as well.  Dr. Rob is also treating for nausea and GI discomfort, so that eases my mind.  I've always been afraid that Hudson isn't feeling well, but doesn't show me.  (He only rarely will pass food by.)

Kinavet Follow Up

Hudson went in for a post Kinavet follow up today.  I had found two more masses since we last were in, so we had cytologies done for both.  There was a mass on his hip which was found to be a benign cyst.  There is a small infected looking mass in his mouth by his front bottom teeth.  That was determined to be a benign infection.  Good news for both of those.  (The mass is visible in the pic below on the lower left side of his mouth.

As usual when starting a new chemo, Hudson's white blood cell count fell lower than anticipated while on the Kinavet.  We are taking a one week break from his Kinavet treatment (and taking Cyclophosamide every day) before reintroducing it at a lower dosage.  Dr. Janson said that she has never treated a Dane that didn't have sensitive bone marrow when it comes to chemo. :)  He had been fairly lethargic on his Kinavet days, so I was anticipating his low white cell count.

This was Dr. Janson's last appointment with us prior to the birth of her baby, so she discussed next steps and provided contact info for her maternity back up, Dr. Phyllis Glawe from Deer Creek Animal Hospital.  We have an appointment set up to see her on May 31st.

Things NOT to Say to a Pet Parent Struggling with Cancer

• Your dog is really lucky you're willing to do that.  I think that this is intended as a compliment, of sorts.  However, it comes across with a silent "because I sure as hell wouldn't" attached.
• Why are you spending so much money on a dog?  This one particularly upsets me.  It's my money and I can spend it however I like.  If your child was sick, I would never question you spending money to save them, even if it was to prolong their life for a very limited time.  Hell, I don't care if you blow all your money on a convertible.  It's not my money and how you spend it doesn't affect me.
• How much time does he have left?  I think the intention here is good, but any time you remind me that my dog is dying, that's not helpful.  Even though Hudson is doing well and is happy, the end result of osteosarcoma is always in the back of my mind, I don't need any reminders.
• Isn't it cruel to put him through all that?  Making the decision to amputate and treat with chemo is extremely difficult.  You second guess yourself constantly.  You struggle with your choice every time even a hint of a side effect occurs.  The last thing you need to hear is someone implying that you are purposely hurting your pet.
• I would never treat my dog with chemotherapy, it's so hard on him.  This is almost the same as the "isn't it cruel" comment above, only this one punches you in the heart.  This is almost an accusational comment.  I felt like I was personally being attacked.  To make it even worse, we'd only just gotten out of the hell week after amputation when this comment was made.  I was already physically and emotionally exhausted, and this really hurt.  It doesn't matter that the person knew nothing about canine chemo and its side effects.  In fact, that makes it worse.  I was being judged for something that the person knew nothing about.
• How will you know when it's time to put him down?  There isn't a day that goes by that this isn't already on my mind.  Please don't ask me to make you a checklist.
• Oh...cancer....that's a death sentence.  I know that.  Trust me, that's the first thing I thought of when the vet gave me the diagnosis.  The last thing that someone fighting osteosarcoma needs to hear is the worst case scenario.

2 Month Follow Up Appointment

Hudson had his two month follow up appointment today.  I was very optimistic going into this check-up, which as anyone who reads this blog knows, is not common for me.  I tend to be a "the glass is bone dry" kind of girl.  I feel that it better prepares me to deal with the worst, if it comes.

We did the normal stuff, a CBC (normal,) a renal profile (normal,) a urinalysis (normal,) and chest x-rays.  As you may recall, there were three metastatic nodules (tumors) in Hudson's lungs at the last check up.  The big guy (previously walnut sized) is completely gone!  Of the smaller two, one has decreased in size marginally, and the other remained the same.  Obviously, this is great news as it means that Hudson's cancer is reacting well to the chemo and he's got partial remission in his lungs.  He's doing great...

Until they checked the bump on Hudson's shoulder for me.  I had convinced myself that it was a cyst, mostly because I really really wanted it to be a cyst.  It's not a cyst.  It's a metastatic osteosarcoma tumor.

Hudson is already on metronomic low dose chemotherapy that has been working in his lungs.  He receives Cyclophosphamide (Cytoxan,) Doxycycline, and Carprofen daily.  We are going to now add a fourth drug, Kinavet, to the mix in an attempt to treat the new resistant cells that have formed the mass on his shoulder.  He will begin receiving 13 mg of Cyclophosphamide every other day alternating with the Kinavet (675 mg.)

Kinavet is a slightly more aggressive drug, and has a higher likelihood of side effects, which can include nausea, vomiting, a marked decrease in appetite, blood in the stool, low white blood cell counts, and rarely kidney and liver dysfunction.  Hudson will need to return to see Dr. Janson two weeks after starting Kinavet.  At that time, we will do a CBC and measure the shoulder mass to see if there has been any effect.  He will return another 2 weeks after that for the same.  If the Kinavet does not work by that point, it won't ever and we will need to review further options.

Just as a comparison point, a one month supply of Kinavet costs approximately $450.  A one month supply of Cyclophosphamide is approximately $45.  A two week supply of Doxycycline is $16, and a one month supply of Carprofen costs approximately $36.

Prior to the introduction of Kinavet, our monthly med bill for Hudson was $113.00.  With Kinavet, it will be $563.00.  Tony and I discussed it, and despite our tight finances, we are proceeding with Kinavet treatment.

E-mail Update from Tony

As promised, here is Hudson's checkup summary....
 
Dr. Janson said he looked great! She said his weight looks very good and he has dropped 6.6 pounds. He is at 117.2. His white blood cell count is good. As far as the chest xray, she said the 2 little (1cm) nodes from last time have remained the same size, and the bigger one has shrunk considerably. It is now smaller than a walnut. His urinalysis and renal profile looks good with no concerns there. His heart and lungs auscult normally. She said he should remain on the same medicinal regiment he has been on with no changes. Because he is looking so good, she doesn't need to see him for 2 months. She just said to continue monitoring his urine for any signs of straining, and/or blood. She said he is in a "stable state" which means there is no concern at this time.

To Hudson's Patiently Awaiting Public....He's Back...and he peed on me

Dr. Janson officially lifted the "public" ban on Monday at Hudson's most recent oncology appointment.  His white cell count came back at a healthy enough level that he can return to visiting the dog parks, going to BDHPI events and peeing on stuff (and subsequently laughing when I have to buy aforementioned urine soaked items) at Petsmart. 


Speaking of urine soaked items, we were required to capture and deliver a urine sample to Dr. J and team.  I joked ahead of time with my co-workers that I was bound to get peed on.  I had initially planned on fashioning a pee collection implement by taping the sample cup to a pole, but decided against it.  With my luck, as I removed the implement, I'd tip it and the sample would spill out.  Instead, I decided to brave the rapids and go in myself.


Monday afternoon, I arrived home from work and let Porter and Lexi outside.  Hudson had to hold it a little longer while I got my pee catching instruments prepared.  I removed the sample cup from its plastic bag and slid bright blue latex gloves onto my hands.  I let Hudson out the door and then ran in pursuit.  He went to pee on the fence and I dove underneath to capture it.  He reared around to observe me with a look on his face that clearly indicated his doubts about my sanity.  As his stream began to peter out (please pardon the pun), it became less precise.  He managed to hit my right forearm from wrist to elbow, missing ENTIRELY THE BLUE GLOVES.  Not a drop landed on the gloves.  I feel that this was likely on purpose.


My sacrifice was not wasted, however.  Despite the disgustingness dripping down my arm, I managed to seal the sample cup and get it to his vet, after copious scrubbing of my arm.  Hudson's urinalysis came back good and we are cleared to continue oral chemo at his present dosage.


In four weeks, on February 13th, we go back for another urinalysis, blood test, and chest xrays.  Since I'm me, I'll be stressing that for the entirety of the next few weeks.  Even worse, I'm going to be out of the country for work when this happens.  I'll be scaring the crap out of myself in Poland as I wait to hear what shows up.  Tony is going to take Hudson to his appointment and has been instructed to record everything the doctor says on his iPhone and play it back for me.  His detail relay skills are not up to my exacting requirements.